Broker Selection Option Request Form

Note: FedEx Express is unable to send shipments in-bond to the following locations:
Eagle Pass TX, and Blaine WA. If your Customs Broker is located in one of these locations, please
contact the trace agent listed at the bottom of this form for further assistance. However, if your customs
broker has the capability to make entry in the port that is the BSO location for the address indicated for
the broker, we can handle the shipment as a BSO.

This form indicates your choice to send a single shipment in-bond for clearance, OR to instruct FedEx
Trade Networks to send this shipment and all future shipments in-bond for clearance. Please choose
ONLY ONE option below:

FedEx waybill # _____________________

448821738097 Electric Guitar
Description_________________________
Value __________________
3200 EUR Weight __________
7 KG ___ LB ___

SINGLE SHIPMENT
Gonzalo Alee
I, _______________________, authorize Federal Express Corp. to process this single shipment, listed
above, as a Broker Selection Option. I designate the customs broker listed to handle this entry on my
behalf. Please forward to the broker listed below.

ALL FUTURE SHIPMENTS

I, _______________________, authorize Federal Express Corp. to process this shipment, AND ALL
FUTURE shipments as a Broker Selection Option. I designate the customs broker listed below to make
entry on all future shipments on my behalf. Please forward to the Customs Broker listed below:

Customs Broker: ___________________________ Daniel Mendez

International Trinity Customs Brokers Contact Name: _______________________

Address: 4552 SW 164 PL

_________________________________ MIAMI, FL 33185
City/State/Zip: ________________________
Phone No: ________________________
786-350-6327 Fax No: _______________________
daniel.mendez@trinitycb.com
Email: ____________________________

-----------------------------------------------------------------------------------------------------------------------
MANEIMPORT CARGO SUD/ GONZALO ALEE
Company Name: _________________________________________________________
Address: 4320 NW 72ND AVE
_________________________________________________________
City, State, Zip MIAMI FL 33166
_________________________________________________________
Phone: _______________ Fax: __________________ Email: _______________________
Contact name: ___________________________
-------------------------------------------------------------------------------------------------------------------------------
By signing this form, I understand and accept that the fees charged by my chosen customs broker are for my account alone and
that neither FedEx Express nor FedEx Trade Networks Transport & Brokerage will be responsible for any additional costs
associated with this selection. I will be responsible for making all necessary arrangements with the customs
broker listed above to complete the clearance of this shipment.

1
I understand and accept that FedEx Express does not allow Remote Location Filing (RLF) of entries for
Broker Select Option (BSO) shipments in FedEx Express clearance ports (Port Codes 2095, 2895, 2991,
3195, 4198, 4671, 4770, and 5297) by non-FedEx Express customs brokers. BSO shipments are routed
in-bond to a FedEx ramp facility closest to the customs broker’s zip-code/address for clearance.

I understand and accept that, after my broker notifies FedEx Express the Customs clearance and all other
required government agencies clearances have been obtained, FedEx Express will deliver the shipment to
the address indicated on the air waybill. Further, I understand and accept that increased transit times may
result by my selection of this service and that additional transportation charges may be incurred if the air
waybill destination is outside the immediate delivery area of the customs brokers address. Please contact
FedEx Express Customer Service at 800-247-4747 regarding those additional charges.

GONZALO ALEE MANEIMPORT CARGO SUD.

Printed Name: __________________________ Company Name: ____________________

Title: ____________________________

Signature: _______________________________________ 07/24/2018

Date: ____________________________

Instructions for Completion of the Broker Select Option (BSO) form

This form is to be completed by customers who wish to use a customs broker other than FedEx Trade Networks Transport &
Brokerage to facilitate customs clearance for their company’s U.S. import shipments.

This form must be duplicated or a separate sheet attached to designate the BSO option for additional locations or company
affiliations.

Customer Information

Please print the company’s name, address, etc, as it would appear on the commercial invoice for import shipments. (No P.O.
Boxes)

Customs Broker Information

Please indicate the customs broker’s complete name & address with city, state, and Zip code. Please ensure the postal code is
correct. An invalid code could cause shipment routing errors or delays. A contact name, with phone and fax numbers, is
necessary for broker notification.

----------------------------------- FedEx Trade Networks (FTN) use only ---------------------------------------

FTN Agent: ____________________________________ Employee #:____________________

Phone: ______________ Fax: ______________________